Senate Bill No. 487

(By Senators Minard and Jenkins)


[Introduced February 11, 2003; referred to the Committee on Health and Human Resources; and the to the Committee on the Judiciary.]


A BILL to amend and reenact section one, article three-c, chapter thirty of the code of West Virginia, one thousand nine hundred thirty-one, as amended, relating to peer review organization protection; and adding health maintenance organization review committee to the definition of "review organization"

Be it enacted by the Legislature of West Virginia:
That section one, article three-c, chapter thirty of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended and reenacted to read as follows:
§30-3C-1. Definitions.
As used in this article:
"Health care professionals" means individuals who are licensed to practice in any health care field under the laws of this state.
"Peer review" means the procedure for evaluation by health care professionals of the quality and efficiency of services ordered or performed by other health care professionals, including practice analysis, inpatient hospital and extended care facility utilization review, medical audit, ambulatory care review, and claims review.
"Professional society" includes medical, psychological, nursing, dental, optometric, pharmaceutical, chiropractic and podiatric organizations having as members at least a majority of the eligible licentiates in the area or health care facility or agency served by the particular organization.
"Review organization" means any committee or organization engaging in peer review, including a hospital utilization review committee, a hospital tissue committee, a medical audit committee, a health insurance review committee, a health maintenance organization review committee, a hospital plan corporation review committee, a professional health service plan review committee or organization, a dental review committee, a physicians' advisory committee, a podiatry advisory committee, a nursing advisory committee, any committee or organization established pursuant to a medical assistance program, and any committee established by one or more state or local professional societies or institutes, to gather and review information relating to the care and treatment of patients for the purposes of: (i) Evaluating and improving the quality of health care rendered; (ii) reducing morbidity or mortality; or (iii) establishing and enforcing guidelines designed to keep within reasonable bounds the cost of health care. It shall also mean any hospital board committee or organization reviewing the professional qualifications or activities of its medical staff or applicants for admission thereto, and any professional standards review organizations established or required under state or federal statutes or regulations.

NOTE: The purpose of this bill is to add peer review committees established by Health Maintenance Organizations to the definition of "review organizations," thereby making the proceedings and records of a Health Maintenance Organization peer review committee confidential and privileged to the same extent as are the proceedings and records of peer review committees of other health insurance review committees.

Strike-throughs indicate language that would be stricken from the present law, and underscoring indicates new language that would be added.